Guglielmo Giraldi

The Role of 3 Tesla Diffusion-Weighted Imaging in the Differential Diagnosis of Benign versus Malignant Cervical Lymph Nodes in Patients with Head and Neck Squamous Cell Carcinoma

Objective. The aim of this study was to validate the role of diffusion-weighted imaging (DWI) at 3 Tesla in the differential diagnosis between benign and malignant laterocervical lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC). Materials and Methods. Before undergoing surgery, 80 patients, with biopsy proven HNSCC, underwent a magnetic resonance exam. Sensitivity (Se) and specificity (Spe) of conventional criteria and DWI in detecting laterocervical lymph node metastases were calculated. Histological results from neck dissection were used as standard of reference. Results. In the 239 histologically proven metastatic lymphadenopathies, the mean apparent diffusion coefficient (ADC) value was 0.903 × 10−3 mm2/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10−3 mm2/sec was found. For differentiating between benign versus metastatic lymph nodes, DWI showed Se of 97% and Spe of 93%, whereas morphological criteria displayed Se of 61% and Spe of 98%. DWI showed an area under the ROC curve (AUC) of 0.964, while morphological criteria displayed an AUC of 0.715. Conclusions. In a DWI negative neck for malignant lymph nodes, the planned dissection could be converted to a wait-and-scan policy, whereas DWI positive neck would support the decision to perform a neck dissection.

The synergistic effect of exposure to alcohol, tobacco smoke and other risk factors for age-related macular degeneration.

Age-related macular degeneration (AMD) is the leadingcause of severe visual loss among people aged 50 yearsand older in the developed world [1]. Cigarette smoking,hypertension, inflammation and alcohol consumption, havebeen shown to be associated with AMD in some, but not allstudies [2–4]. In our study we have evaluated the syner-gistic effect of alcohol and tobacco smoking with other riskfactors in the risk of developing AMD.The investigation adhered to the Declaration of Helsinkiand was approved by the Ethics Committee. We recruitedpatients, providing written informed consent, with AMD(the phenotype was early AMD, both the drusen and thepigmentary changes) during the period between August andNovember 2011 from the Center Maculopathy of theDepartment Sense Organs Sapienza University of Rome,Teaching Hospital Umberto I.The controls, matched to cases by age and sex, consist oftwo distinct groups:a) patients with eye diseases (unrelated with AMD);b) individuals belonging to the Clinic Orthopedic of theTeaching Hospital Umberto I, Rome.A questionnaire was administered to cases and controlsfor collecting data including thirty-five questions dividedinto five sections. The first section asked for demographicdata regarding age, gender, occupation, education level,weight, height, eyes colour. The second section asked forAMD family history (any relative), cardiovascular disease,hypertension, hypercholesterolemia, diabetes, cataractsurgery. The third section ascertained whether the patientsare ever smokers. The fourth section asked if the patientsdrink wine, beer or hard liquor. The last section tested howmany times a week, patients eat the following foods: bread,pasta, legumes, fruit, vegetables, red meat, white meat,cheese, fish, sweets.The possible interaction between sociodemographicvariables was tested using the synergism index, calculatedas follows: S = [OR11 - 1]/([OR01 ? OR10] -2), whereOR11 is equal to OR of the joint effect of two risk factorsand OR10 and OR01 are equal to OR of each risk factor inthe absence of the other. A value of S equal to unity wasinterpreted as indicative of additivity, whereas a valuegreater than unity was indicative of superadditivity andsynergism [5].A total of 122 cases and 124 controls were enrolled.The median age in the case group was 75, whilst in thecontrol group was 74. Alcohol intake is the same in bothgroups (2.4 grams per day); as regards smoking condi-tion, we found that 61.5 % (75 persons) in the case groupare ever smokers, in the control group they are 41.9 %(52 persons).Table 1 shows OR for each variables AMD-related.There was an indication for the additivity and synergismbetween many risk factors (Table 2): family history AMDand ever smokers (S = 1.51; 95 %CI 0.11–20.69), hyper-cholesterolemia and ever smokers (S = 1.77; 95 %CI0.44–7.10), finally from hypercholesterolemia and alcoholintake (S = 1.64; 95 %CI 0 -[999). Moreover, we foundout a synergistic interaction for Obesity with Ever smokers(1.54; 95 %CI 0.24–9.63) and Alcohol intake (4.2; 95 %CI0 -[999).Our findings suggest that many risk factors are associ-ated to the development of AMD, some of them have a

Magnetic resonance imaging tumor regression shrinkage patterns after neoadjuvant chemotherapy in patients with locally advanced breast cancer: Correlation with tumor biological subtypes and pathological response after therapy:

The objective of this study is to analyze magnetic resonance imaging shrinkage pattern of tumor regression after neoadjuvant chemotherapy and to evaluate its relationship with biological subtypes and pathological response. We reviewed the magnetic resonance imaging studies of 51 patients with single mass-enhancing lesions (performed at time 0 and at the II and last cycles of neoadjuvant chemotherapy). Tumors were classified as Luminal A, Luminal B, HER2+, and Triple Negative based on biological and immunohistochemical analysis after core needle biopsy. We classified shrinkage pattern, based on tumor regression morphology on magnetic resonance imaging at the II cycle, as concentric, nodular, and mixed. We assigned a numeric score (0: none; 1: low; 2: medium; 3: high) to the enhancement intensity decrease. Pathological response on the surgical specimen was classified as complete (grade 5), partial (grades 4–3), and non-response (grades 1–2) according to Miller and Payne system. Fisher test was used to relate shrinkage pattern with biological subtypes and final pathological response. Seventeen patients achieved complete response, 25 partial response, and 9 non-response. A total of 13 lesions showed nodular pattern, 20 concentric, and 18 mixed. We found an association between concentric pattern and HER2+ (p < 0.001) and mixed pattern and Luminal A lesions (p < 0.001). We observed a statistical significant correlation between concentric pattern and complete response (p < 0.001) and between mixed pattern and non-response (p = 0.005). Enhancement intensity decrease 3 was associated with complete response (p < 0.001). Shrinkage pattern and enhancement intensity decrease may serve as early response indicators after neoadjuvant chemotherapy. Shrinkage pattern correlates with tumor biological subtypes.

Knowledge, attitudes and behaviours on doping and supplements in young football players in Italy.

• This study investigates knowledge, attitudes and behaviours of young amateur players about doping (growth hormone, anabolic steroids) and the use of nutritional supplements (amino acids, creatine) in sport.

What is the impact of reporting guidelines on Public Health journals in Europe? The case of STROBE, CONSORT and PRISMA

BACKGROUND The aim was to evaluate the use of PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), CONSORT (Consolidated Standards of Reporting Trials) and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) methods in reviews, clinical trials and observational studies, respectively, which were published in European journals within the field of Public Health (PH). METHODS Papers published between 2010 and 2013 in seven PH journals were evaluated. The presence of the words PRISMA, STROBE and CONSORT was considered in the search criteria. RESULTS In total, 2355 of 3456 retrieved articles were included: 1.5% appeared to follow the guidelines. The boundaries within which the criteria were applied are 0-100% for CONSORT, 0-0.6% for STROBE and 0-37% for PRISMA. CONCLUSIONS A strong heterogeneity in the application of guideline statements was observed. A common agreement among journals regarding research-reporting methodologies could improve the quality of PH research publishing.

Reliability of the telephone-administered International Physical Activity Questionnaire in an Italian pilot sample

Background: the International Physical Activity Questionnaire (IPAQ) is an instrument for crossnational monitoring of physical activity and inactivity. The aim of the study was the reliability evaluation of the Italian telephone-administered IPAQ version in Rome. Methods: the IPAQ short form (IPAQ-SF), consisting of 7 items, was administered. The responses, used to compute Metabolic Equivalent Task (MET in minutes per week), were processed to analyze the internal consistency. Standardized Cronbach’s alpha was used for reliability estimation. Results: a total of 133 adults (51 males and 82 females) participated in the study, with a mean age of 51 years (SD=19). The mean MET was 4 130, corresponding to good physical activity levels. The standardized Cronbach’s alpha on 6 items, concerning time spent on vigorous and moderate activity and walking, was 0.614. Conclusions: according to the findings from other countries, the Italian IPAQ-SF has acceptable measurement properties, as good as other established self-reports. The IPAQ-SF has a questionable reliability as previously reported, but the results of the present pilot study are promising and suggest that these instruments can be used to compare population estimates of physical activity.

Investigation of the effects of vitamin D and calcium on intestinal motility: In vitro tests and implications for clinical treatment.

Abstract The presence of vitamin D receptors in small intestine muscle cells may lead one to think that vitamin D may act locally, influencing intracellular calcium concentration and contributing to the contraction-relaxation regulation of the intestinal smooth muscle cells. This study investigates the potential effects of vitamin D and calcium on intestinal motility using an in vitro test. Different calcium concentrations added to the tissue not pre-treated with 1,25-dihydroxycholecalciferol [1α,25(OH)2D3] produced no response at low doses (1.25 × 10−3 and 2.0 × 10−3 mol L−1) and only a very weak response at higher concentration (3.0 × 10−3 mol L−1). The addition of 1α,25(OH)2D3 (1.44 × 10−10 mol L−1) had no effect on isolated ileum motility. When calcium (3.0 × 10−3 mol L−1) was added after at least 3 hours, it evoked evident and persistent contractions for 60–90 minutes. The contractions were at about 40 % of the peak produced by acetylcholine. Thus, simultaneous intake of vitamin D and calcium might be a useful co-adjuvant in intestinal atony therapy aimed to stimulate normal gut motility in humans. These findings imply that supplemental vitamin D may be important in all cases where calcium has to be prescribed.

Smoking-Related Cancer Epidemiology

This section intends to describe the epidemiology of cigarette smoking-related cancers. For each disease, the epidemiology and the scientific evidence will be discussed.

Knowledge, opinions and attitudes of Italian mothers towards HPV vaccination and Pap test.

Aim This study evaluated the knowledge and attitudes of Italian mothers – whose daughters had been vaccinated in 2012 – towards primary (anti-HPV vaccination) and secondary (Pap test screening) cervical cancer prevention, as well as sources of information and mother-daughter communication on health issues. Methods The survey – part of a multicenter study carried out in 4 Italian cities (Ferrara, Rome, Cassino and Palermo) – was conducted through self-administered questionnaires. The first univariate analysis evaluated differences between mothers of under-18s and over-18s relative to knowledge and attitudes on HPV vaccination and Pap test. The second univariate analysis evaluated differences between the 2 groups of mothers and possible geographical variations regarding the sources of information on HPV and Pap test. Results The sample proved knowledgeable about the correlation between HPV and cervical cancer (>85%) but less aware of other HPV-related diseases. HPV vaccination should be administered before first sexual intercourse according to mothers of over-18s, and to 14- to 17-year-olds according to mothers of under-18s. Up to 88% of mothers of under-18s and 80% of mothers of over-18s declared that the vaccine should be given free of charge. More mothers of under-18s consulted a general practitioner (GP) or gynecologist before deciding to vaccinate their daughters. Mothers of under-18s received information on HPV vaccination mainly from GPs and gynecologists, while mothers of over-18s were informed through TV and books/journals. Over 80% of the sample declared satisfaction with the information received from their gynecologist during the Pap test. Conclusions The findings provide useful information for the development of effective public health interventions that may help improve acceptance of HPV vaccination among mothers.

Primary colonic lymphoma: An incidental finding in a patient with a gallstone attack

We report a case of primary colonic lymphoma incidentally diagnosed in a patient presenting a gallbladder attack making particular attention on the diagnostic findings at ultrasound (US) and total body computed tomography (CT) exams that allowed us to make the correct final diagnosis. A 85-year-old Caucasian male patient was referred to our department due to acute pain at the upper right quadrant, spreaded to the right shoulder blade. Patient had nausea and mild fever and Murphys maneuver was positive. At physical examination a large bulky mass was found in the right flank. Patient underwent to US exam that detected a big stone in the lumen of the gallbladder and in correspondence of the palpable mass, an extended concentric thickening of the colic wall. CT scan was performed and confirmed a widespread and concentric thickening of the wall of the ascending colon and cecum. In addition, revealed signs of microperforation of the colic wall. Numerous large lymphadenopathies were found in the abdominal, pelvic and thoracic cavity and there was a condition of splenomegaly, with some ischemic outcomes in the context of the spleen. No metastasis in the parenchimatous organs were found. These imaging findings suggest us the diagnosis of lymphoma. Patient underwent to surgery, and right hemicolectomy and cholecystectomy was performed. Histological examination confirmed our diagnosis, revealing a diffuse large B-cell lymphoma. The patient underwent to Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone chemotherapy showing only a partial regression of the lymphadenopathies, being in advanced stage at the time of diagnosis.